Posters

Technique of injecting correct dosage of anti-VEGF

Poster Details

First Author: G.Murthy INDIA

Co Author(s): P. Mahajan

Abstract Details

Purpose:

The invent of intravitreal anti-VEGF injections has revolutionized the treatment of posterior segment diseases notably diabetic macular edema, wet AMD or vein occlusions.
The need for frequent injections combined with their high cost is one of the most important constraining factor.
During every intravitreal injection there is wastage of the drug remaining in the hub of the needle as well as sometimes air entry .
To avoid wastage of the drug remaining in the hub of the needle during intravitreal injection a proper technique of drug injection is required.

A prospective non randomized interventional study. 250 patients attending retina clinic of MRC eye hospital, a tertiary eye hospital located in Mysore, India who received intravireal injections between Oct 2015 to Oct 2016.
Informed consent was obtained before the actual procedure.
250 eyes of 250 patients who underwent intravitreal injection had diabetic macular edema (n=23/46%), wet AMD (n=20/40%) and Vein occlusion (n=7/14%).
Procedure was done in sterile operation theatre.
All the injections were given by same surgeon. After preparing the injection the syringe was held upside down (i.e. needle downward) and gentle tap was done on the syringe to move the air bubble up if there was any trapped in the needle hub to drive the air bubble towards the injector.
After instillation of a drop of 0.5% proparacaine and with proper aseptic precautions, a universal eye speculum was applied and intravitreal injection given at the appropriate distance by measuring with a caliper.

Results:

All two hundred and fifty eyes of two hundred and fifty patients had no air bubble inside the eye and none complained of seeing a black floater. 10 percent of patients complained of some discomfort in the injected eye and none had raised IOP or any serious complication. There was only minimal quantity if any of the drug left over in the used syringes.

Conclusions:

A small step before the injection of intravitreal agents can ensure an appropriate dosage and reduce wastage of the valuable drugs.
In developing countries where bevacizumab is used more often as it is cost effective this can reduce the cost further as it can be used for more people.